Many experts believe the best treatment for fibromyalgia is a multifaceted approach that combines medication with lifestyle changes and alternative treatments. And, it looks like Mommy and I have been left alone to learn how to manage/treat/cope/handle/survive (choose the most appropriate verb) my fibromyalgia. Having read lots of your stories and received plenty of advice, I am working on my own treatment plan – do I have a choice?

But what about if you’re new to all of this? Where do you even start?

A treatment plan gives structure to getting from here to there. Be realistic and (yes, you’re already probably sick of hearing this already) small steps! A treatment plan is different from devising goals because of its flexibility and internal exploration. In most clinical settings, a treatment plan review is done quarterly or even monthly. After each review, the plan is rewritten to meet current needs.

Start With a Diagnosis

There are no lab tests for fibromyalgia. Doctors diagnose it by considering criteria such as how long you’ve had pain and how widespread it is, and by ruling out other causes. This can be a long and complicated process because the symptoms associated with fibromyalgia can be caused by other conditions. So it’s best to see a doctor who is familiar with fibromyalgia – which can be easier said than done, sometimes!

Once you’ve been diagnosed with fibromyalgia, your doctor will talk to you about treatment options. Several types of medicines are used to help manage fibromyalgia symptoms such as pain and fatigue.

Three medications are FDA-approved to treat fibromyalgia:

Cymbalta (duloxetine): a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI). Researchers aren’t sure how Cymbalta works in fibromyalgia, but they think that increasing levels of serotonin and norepinephrine help control and reduce feelings of pain.

Lyrica (pregabalin): Lyrica is a nerve pain and epilepsy drug. In people with fibromyalgia, it may help calm down overly sensitive nerve cells that send pain signals throughout the body. It has been effective in treating fibro pain.

Savella (milnacipran): Savella is also an SNRI. While researchers aren’t exactly sure how it works, studies have shown that it helps relieve pain and reduce fatigue in people with fibromyalgia.

Antidepressants are also sometimes prescribed to help people manage fibromyalgia symptoms:

Tricyclic antidepressants. By helping increase levels of the brain chemicals serotonin and norepinephrine, these medications may help relax painful muscles and enhance the body’s natural painkillers.

Selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressants by itself or in combination with a tricyclic antidepressant. SSRIs prevent serotonin from being reabsorbed in the brain. This may help ease pain and fatigue.

These medications are also sometimes prescribed for fibromyalgia:

Local anesthetics. Injected into especially tender areas, anesthetics can provide some temporary relief, usually for no longer than three months.

Anticonvulsants or seizure medications such as Neurontin are effective for reducing pain and anxiety. It is unclear how these medications work to relieve the symptoms in fibromyalgia.

Muscle Relaxants are occasionally prescribed to help alleviate pain associate with muscle strain in those with fibromyalgia.

Stay Active

Exercise is an important part of managing fibromyalgia symptoms. Staying physically active can relieve pain, stress, and anxiety.

The key is to start slowly. Begin with stretching and low-impact activities, such as walking, swimming or other water exercises, or bicycling. Low-impact aerobic exercises such as yoga, tai chi, or Pilates can also be helpful. Prior to starting any exercise routine, or if you want to increase the intensity of your exercise, talk with your doctor.

Physical Therapy

Physical therapy can help you get control of your illness by focusing on what you can do to improve your situation, rather than on your chronic symptoms.

A physical therapist can show you how to get temporary relief from fibromyalgia pain and stiffness, get stronger, and improve your range of motion. And she can help you make little changes, such as practicing good posture, that help prevent painful flare-ups.

A number of popular fibromyalgia treatments fall outside the realm of mainstream medicine. In general, there hasn’t been extensive research on complementary and alternative medicine (CAM), but anecdotal evidence suggests that some may work. Always talk with your doctor before starting any alternative treatment.

Popular alternative treatments include:

Acupuncture. This ancient healing practice aims to increase blood flow and production of natural painkillers with thin needles inserted into the skin at strategic points on the body. Some studies report that acupuncture may help ease pain, anxiety, and fatigue.

Massage therapy. This may help reduce muscle tension, ease pain in both muscles and soft tissue,improve range of motion, and boost production of natural painkillers.

Chiropractic treatment. Based on spinal adjustments to reduce pain, this popular therapy may help relieve fibromyalgia symptoms.

Supplements. A number of dietary and other supplements are touted as treatments aimed at relieving fibromyalgia symptoms. Some of the most popular for fibromyalgia include magnesium, melatonin, 5-HTP, and SAMe, which may affect serotonin levels. However, results of studies on these supplements are mixed. Be sure to talk with your doctor before taking any supplements. Some may have side effects and could react badly with medication you are taking.

Herbs. As with supplements, scientific evidence for the effectiveness of herbs is mixed. A few studies have shown that St. John’s wort can be as effective as certain prescription medication for treating mild depression.

This is just a start – and you will probably need to tweak your plan as you go along, throwing out activities and treatments that don’t work for you, while grasping the positives with both hands. Remember, it may take a while to get where you want to be – it is all about experimentation (and just because something works for me does not mean it will work for you). Lastly, try not to get discouraged (Ha!) but we’re all here to support you.